Fibroma Cardíaco: seguimento a longo prazo por ressonância magnética cardíaca / Cardiac Fibroma: long-term follow-up by cardiac magnetic resonance

As neoplasias cardíacas primárias são raras, e o diagnóstico correto é essencial para planejar o tratamento mais adequado. O objetivo deste estudo foi demonstrar o papel da ressonância magnética cardíaca na avaliação, no diagnóstico e no acompanhamento de fibroma cardíaco. Paciente do sexo feminino, 21 anos, com massa miocárdica ao ecocardiograma. Realizou ressonância magnética com diagnóstico de fibroma cardíaco. Foi acompanhada durante 6 anos com estabilidade do quadro. Fibromas cardíacos correspondem à segunda neoplasia mais comum em crianças e jovens. À ressonância magnética, caracterizam-se por realce tardio intenso e homogêneo.(AU)

Stiff Left Atrium Syndrome After Atrial Fibrillation Ablation ­ A Diagnosis Not To Forget

Atrial fibrillation is the most prevalent arrhythmia in clinical practice and has different strategies for its control. Of these strategies, the percutaneous ablation of the pulmonary veins stands out, with robust results in relation to drug treatment. It is an invasive procedure and, therefore, not free from complications, which must be properly diagnosed and treated. Among the possible complications, there is stiff atrium syndrome, characterized by reduced atrial compliance caused by post-ablation fibrosis, which, in turn, leads to atrial filling dysfunction and the consequent increase in atrial and venous capillary pulmonary pressures. The case report demonstrates this infrequent but important complication, which presents good results for clinical treatment, in addition to the contribution of cardiac magnetic resonance in its diagnosis and in the assessment of arrhythmia recurrence rates.

Prevalence of atrial fibrillation and stroke risk assessment based on telemedicine screening tools in a primary healthcare setting.

BACKGROUND: Worldwide atrial fibrillation (AF) prevalence varies between 0.1% and 4.0%, and has been increasing. Little is known about the prevalence of AF in Brazil. Our objective was to estimate the prevalence of AF in several regions of Brazil using recordings of long-distance electrocardiogram (ECG) transmission. METHODS: Patients from 125 outpatient general practitioner units covered by the telemedicine service of the Federal University of São Paulo were included. Only one ECG was considered per patient. A scripted telephone interview was also performed. We analyzed the data to project the prevalence of AF in the Brazilian population and estimate it for the year 2025. The overall AF prevalence was calculated based on ECGs from primary care units where patients went for routine visits. RESULTS: Based on 676,621 ECG exams from January 2009 through April 2016, the mean age (±SD) of patients was 51.38 (±19.05) years, with 57.5% being female. The 7-year period prevalence of AF was 2.2% (n = 14,968). The prevalence of AF countrywide was projected to be 1.5% in 2016 and 1.7% in 2025. In the subset of patients with AF who were interviewed (n = 301), 91 (30.2%) were not receiving any type of treatment for rate or rhythm control. Among patients interviewed, 189 (62.8%) were at high risk for stroke; only 28 (14.8%) were regular oral anticoagulant users. CONCLUSIONS: Our study highlights the importance of screening for AF in the primary care setting in Brazil and identifies important gaps in the treatment of AF in this population.

Análise do strain por ressonância magnética em cardiomiopatia siderótica antes e após terapia de quelação de ferro / Magnetic resonance strain analysis in siderotic cardiomyopathy before and after iron chelation therapy

INTRODUÇÃO: Hemocromatose juvenil é uma condição rara de sobrecarga de ferro que causa cardiomiopatia. O distúrbio do metabolismo do ferro que induz à insuficiência cardíaca ainda não é totalmente compreendido, mas a disfunção miocárdica parece ser intimamente relacionada à deposição de ferro nos miócitos. A ressonância magnética cardíaca (RMC) é o método padrão para detecção de ferro nos tecidos. OBJETIVO: Avaliar o strain global circunferencial pela ressonância magnética cardíaca (SGC-RM) em um grupo de pacientes com hemocromatose juvenil e cardiomiopatia secundária à deposição de ferro e sua relação com a concentração de ferro no miocárdio detectada por RMC com a técnica doT2*. MÉTODOS: Estudo de coorte retrospectivo, de três pacientes de uma família diagnosticada com hemocromatose juvenil (mutação HAMP na região 5'UTR), acompanhados por 5 anos, durante o tratamento com quelante de ferro. A RMC foi realizada com aparelho Siemens 1,5T. Foram avaliadas as sequências de cine-RM SSFP para avaliação da função ventricular esquerda e análise do strain pelo software CVI®; e T2* para avaliação de depósito de ferro. Foram obtidos a fração de ejeção ventricular esquerda (FEVE) (anormal < 52%) e o strain global circunferencial (SGC-RM) (anormal < -20%)...(AU)

Meta-analysis of polytetrafluoroethylene bypass grafts to infrapopliteal arteries.

CONTEXT: Reports of polytetrafluoroethylene (PTFE) bypass grafting to the infrapopliteal arteries have often used survival analysis of acceptable quality to describe a wide range of long-term results. In theory, these results may be combined if variability between series and time intervals is considered. OBJECTIVE: Meta-analysis was performed to gain insight into long-term graft patency and foot preservation after PTFE bypass grafting to infrapopliteal arteries. DATA SOURCE: Studies published from 1982 through 2001 were identified from the PubMed database and pertinent original articles. STUDY SELECTION: Three investigators selected 43 studies that used survival analysis, reported 2-year patency rates, and included at least 15 bypass procedures. Data extraction and transformation: Based on standard life-tables or survivor curves, an interval success rate was calculated for each month in each series. The monthly success rates were combined across series, enabling construction of pooled survivor curves. DATA SYNTHESIS: Random-effects meta-analysis yielded 5-year pooled estimates (SE) of 30.5% (7.6%) for primary graft patency, 39.7% (5.5%) for secondary graft patency, and 55.7% (5.0%) for foot preservation. During the entire follow-up, pooled estimates were slightly higher for series of PTFE grafts with adjunctive procedures compared with series of PTFE grafts only. Sensitivity analysis: A simulation using only unfavorable assumptions showed a decrease of less than 5% at 5 years for all outcomes, and smaller differences at subgroup meta-analysis. Funnel plots suggested that publication bias was unlikely. CONCLUSION: This meta-analysis indicated moderate success for PTFE bypass grafts to infrapopliteal arteries, but the role of adjunctive procedures at the distal anastomosis remains uncertain.

Relações do nervo axilar com o músculo subescapular: sua importância no acesso deltopeitotal / Relationship between the axillary nerve and the subscapular muscle: its impotance in deltoid-pectoral access

Foram estudadas 20 peças anatômicas de membros superiores para que se pudesse determinar a topografia precisa do nervo axilar (NA) em relação ao músculo subescapular (MSE), analisando-se, ainda, a rotação do membro superior que mais afasta o NA da inserção do MSE no úmero. O trabalho confirma o fato de que a rotação lateral garante maior segurança no procedimento cirúrgico, pois afasta o NA da inserção do tendão do MSE. Portanto, com o conhecimento dos valores dessa relação, através de padronização técnica, podem-se minimizar os riscos de lesão do NA quando se realiza incisão do tendão do MSE na sua margem lateral.